CONCLUSION

Immediate removal of an indwelling catheter after hysterectomy did not differ from catheter removal on postoperative day 1
for recatheterisation, fever, or urinary tract infections, but was associated with fewer reports of severe postoperative pain.

Commentary

Indwelling urinary catheters are frequently used after urogenital surgery to monitor urine output and to prevent urinary retention.
Although there seems to be no clinical uncertainty about the need for an empty bladder before surgery, controversy arises
about the ideal time to remove the catheter. Removal of indwelling catheters tends to be based on personal preference and
tradition rather than evidence from research.1

The study by Dunn et al was carefully designed, with appropriate and clinically relevant outcomes. The major findings were that patients who had
immediate removal of indwelling catheters had no adverse outcomes and reported significantly less pain than patients who had
their catheters removed after 24 hours.

These findings are particularly relevant to health professionals in gynaecology, but should also raise questions for health
professionals working in other surgical services. Urinary catheterisation is not a harmless procedure. Urinary tract infections
account for about 40% of hospital acquired infections, and 80% of urinary tract infections acquired in hospital are associated
with urinary catheters.2 Such infections not only prolong hospital stay and are expensive to treat but also cause unpleasant symptoms.3 Health professionals are guided in practice by the ethical principle of “doing no harm.” The findings of the study by Dunn
et al will support practitioners who want to protect and work in partnership with their patients. Immediate postoperative removal
of catheters is likely to restore dignity and control to patients. If catheterisation cannot be avoided, nurses must aim to
remove the catheter as soon as possible to alleviate unnecessary pain and other risks to patient safety.